Tennessee’s TennCare may not want to pay for nutritional counseling, but the National Institute of Health requires some psychological counseling prior to any bariatric surgery. This counseling includes a psychological evaluation, often with a standardized objective test, as well as interviews to determine a patient’s preparedness for the life change required by weight loss surgery and information about those changes. One reason behind this requirement is that gastric bypass surgery cannot be reversed. It also requires major behavioral change to be successful; if a patient is not compliant with all behavior changes he or she can become very ill – I have even been told about the possibility of death. These are severe consequences for not following doctors orders implicitly.
Yet, the behavior change required is also severe. As a therapist, I see asking that kind of change from someone as setting them up for failure or disappointment because so much change is extremely stressful and mentally and emotionally taxing. I would caution any of my clients attempting such overnight life change, and counsel them on forgiving themselves when they do not stick to their plan. Eating more than planned one day may be a disappointment for someone committed to weight loss, but it can have devastating effects for someone who has had gastric bypass surgery.
Over and over what is written about weight loss surgery states that those with the greatest success are those with the strongest support systems. This life change cannot be done alone. I believe a caring, experienced therapist is an essential part of this change for at least the first year and likely longer. In addition to the stress of behavior and lifestyle change, there can be much emotion and adjustment surrounding body image, clothing choices, and social interactions, which will need to be processed in a safe environment.
Another reason that counseling is essential for weight loss surgery to be effective is addressing the reasons behind the original weight gain. Excessive eating can be a symptom of difficulty with impulse control and/or eating to deal with emotions including sadness, loneliness, self-loathing, boredom, joy, anxiety, excitement, etc. Similarly, excessive eating can be a way for someone to deal with trauma by avoiding thoughts of trauma and trying to avoid (sexual) attention from other people. Whatever motivated excessive eating in the past can not be removed through surgery; it can only be removed through therapeutic processing. Those who do not address those issues will either be unable to maintain the behavior change necessary for the surgery to be a success or they will replace compulsive eating with another “addiction”. After her surgery, Carnie Wilson turned to alcohol. Others may resort to shopping, promiscuity, workaholism, avoidance, etc.
If you are contemplating weight loss surgery, now is the time to seek counseling. Even if your insurance will not fund treatment, practitioners in private practice may be able to offer a sliding-fee scale based on your income. The investment of money, time, and emotions will be worth the support and guidance you receive in learning more about yourself and successfully changing your life.
February 28th, 2011